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Research ArticlePeripheral Nervous System

MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine

L. Hwang, R. Dessouky, Y. Xi, B. Amirlak and A. Chhabra
American Journal of Neuroradiology November 2017, 38 (11) 2203-2209; DOI: https://doi.org/10.3174/ajnr.A5354
L. Hwang
aFrom the Departments of Plastic Surgery (L.H., B.A.)
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R. Dessouky
bRadiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
cDepartment of Radiology (R.D.), Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Y. Xi
bRadiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
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B. Amirlak
aFrom the Departments of Plastic Surgery (L.H., B.A.)
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A. Chhabra
bRadiology (R.D., Y.X., A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
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  • Fig 1.
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    Fig 1.

    3T MRN demonstrating a normal GON. A, Coronal 3D PSIF shows bilateral GONs (arrows). B, Eight-millimeter-thick MIP reconstruction in the coronal plane shows the normal GONs (arrows). C and D, Eight-millimeter-thick isotropic MIP reconstruction in the sagittal plane shows right and left GONs (arrows).

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    Fig 2.

    3D Coronal PSIF images at 3T. A. Enlarged, hyperintense left greater occipital nerve (in comparison with the right). B, Caliber measurements show a larger left occipital nerve (1.6 mm) compared with the right (1.2 mm). C, Signal intensity measurements for both greater occipital nerves and semispinalis capitis muscles.

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    Fig 3.

    Coronal 3D PSIF images at 1.5T. A, Caliber measurements for the right and left GONs. B, Signal intensity measurements for the right GONs and semispinalis capitis muscles.

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    Fig 4.

    3T MRN demonstrating left GON neuropathy in a 62-year-old woman with left occipital neuralgia. A and B, Coronal 3D PSIF and 8-mm-thick MIP reconstruction show an asymmetrically thickened and hyperintense left GON (arrows). C and D, Eight-millimeter-thick isotropic MIP reconstruction in the sagittal planes. Note the normal right GON (arrows in C) and abnormal left GON (arrows in D) with increasing thickening proximal to the muscle entrapment site.

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    Fig 5.

    3T MRN demonstrating persistent right GON neuropathy in a 55-year-old woman with prior right occipital neurolysis and persistent right occipital neuralgia. A, Coronal 3D PSIF shows the surgical scar site (arrow). B, A more anterior coronal image shows minimal hyperintensity of the right GON (arrows). C and D, Eight-millimeter-thick isotropic MIP reconstruction in the sagittal planes. Note the normal persistently hyperintense right GON (arrows in C) and normal left GON (arrows in D).

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    Fig 6.

    Evaluation of the correlation between the duration of migraine symptoms (defined as length of “time” in days from symptom onset to MRN acquisition) and the GON signal yielded a Spearman rank correlation coefficient of −0.499 with P = .351. When we compared the duration of symptoms and the GON diameter using the same statistical methodology, no significant correlation was found (Spearman rank correlation, 0.21; P = .4). The mean duration of migraine symptoms in this cohort of 18 patients was 3415 ± 3127 days (approximately 9 years).

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    Table 1:

    Patient demographic factors (n = 18) and migraine histories prior to MR neurography

    Age (yr)SexMigraine FrequencyaMigraine LateralityPositive Family HistoryPrevious Head Trauma
    Younger than 40Older than 40MaleFemale<15 per mo>15 per moLeftRightYesNoYesNo
    6 (33%)12 (67%)3 (17%)15 (83%)5 (38%)8 (62%)10 (56%)8 (44%)3 (17%)15 (83%)5 (28%)13 (72%)
    • ↵a Five patients were not reported.

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    Table 2:

    Migraine diagnostic and treatment modalities prior to acquisition of MR neurography

    BotoxNerve BlockRadiofrequency AblationPrevious OperationaPrevious Head/Neck Imagingb
    YesNoYesNoYesNoYesNoYesNo
    13 (72%)5 (28%)15 (83%)3 (17%)5 (28%)13 (72%)6 (33%)12 (67%)6 (33%)12 (67%)
    • ↵a Previous migraine operations included occipital nerve neurectomies or neurolysis.

    • ↵b All previous imaging was either standard 1.5T of the brain or cervical spine MRI or CT and evaluated as negative for pathology related to migraine symptoms.

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    Table 3:

    Statistical analysis of differences in GON diameter, signal intensity, calculated SNR, and calculated CNR comparing the symptomatic (subject group) versus asymptomatic (control group) side using a paired t test in patients with unilateral occipital migrainesa

    MRN CharacteristicSubject GroupControl GroupP Value
    Diameter1.77 ± 0.41.29 ± 0.25.001
    Signal269.06 ± 170.93222.44 ± 170.46.043
    SNR15.79 ± 4.5914.02 ± 5.23.009
    CNR2.57 ± 4.89−1.26 ± 5.02.004
    • ↵a All values are mean ± SD.

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    Table 4:

    Intra- and interobserver statistical analysis showing inter- and intraobserver performance among all 4 parameters using ICCs

    ICC
    Reader 1 (initial) versus reader 1 (4 mo later)
        Nerve diameter (mm)0.93
        Nerve signal0.79
        SNR0.74
        CNR0.68
    Reader 1 versus reader 2
        Nerve diameter (mm)0.81
        Nerve signal0.71
        SNR0.67
        CNR0.54
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American Journal of Neuroradiology: 38 (11)
American Journal of Neuroradiology
Vol. 38, Issue 11
1 Nov 2017
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MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine
L. Hwang, R. Dessouky, Y. Xi, B. Amirlak, A. Chhabra
American Journal of Neuroradiology Nov 2017, 38 (11) 2203-2209; DOI: 10.3174/ajnr.A5354

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MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine
L. Hwang, R. Dessouky, Y. Xi, B. Amirlak, A. Chhabra
American Journal of Neuroradiology Nov 2017, 38 (11) 2203-2209; DOI: 10.3174/ajnr.A5354
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